Alliance For Children Internship Application Form

Name: *

First Name Last Name

Phone Number: *

Area Code Phone Number

E-mail Address: *

example@example.com

Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Resume: *

Picture (headshot with white background): *

Please use a headshot wit a white background

Driver's License/Passport/Identification Card: *

Education Completed: *

High School College Graduate School

Language(s): *

TShirt Size:

Type of Internship Interest: *

EDUCATIONAL INTERNSHIP: Internship REQUIRED to complete a degree at a college or university, to include independent study, courses and department field placements; standardly over one or two semesters. EXPERIENTAL INTERNSHIP: Internships associated with someone who would like professional growth likened to an educational internship, but NOT associated with degree requirement; 3-6 month commitment required.

PROGRAM OF INTEREST *

FAMILY ADVOCATE PROGRAM: Specially trained team of Family Advocates help navigate children and their protective family members through the overwhelming process of dealing with a case of child abuse from initial outcry all the way through prosecution, our Family Advocates are there to help families understand the process and successfully access needed resources in our community. Families are referred to our program through our partner agencies. Case management may include resource referrals, court preparation or accompaniment, financial assistance, coordination of emergency needs, or assistance completing Crimes Victims' Compensation applications. Two semester commitment preferred. CLINICAL PROGRAM: MUST BE MASTER LEVEL OR ABOVE Offers both individual and group counseling services to confirmed victims of child abuse and their protective family members. Our clinical counseling staff work closely with clients to determine an individualized treatment program for each child. Counseling modalities utilized include Trauma-Focused Cognitive Behavioral Therapy through individual and group counseling, and Parent-Child Interaction Therapy. CLIENT RELATIONS SPECIALIST PROGRAM: As families become involved with the investigation and our healing services, their experience from entering our family-friendly centers are critical to interventions and healing services. With an emphasis on Trauma Based Relational Interventions (TBRI), interactions with both caregivers and children are a focal point of this program.

The next portion is if you are currently enrolled in school:

College / University:

Department/Degree:

Does your internship require your field supervisor to have a specific degree and/or licensure? *

Yes No Unsure

If yes, please list degree requirement and/or licensure requirement:

Total Number of Hours Needed per Semester:

Length of Internship (if an educational internship):

Split Semesters (2 semesters) Block Semester (1 semester)

Terms:

Fall 2022 Semester Spring 2023 Semester Summer 2023 Semester Fall 2023 Semester Spring 2024 Semester

Start Date:

Date

Completion Date:

Date

Licensure Supervisor/ Field Liaison's Name:

First Name Last Name

Licensure Supervisor/ Field Liaison's Phone Number:

Area Code Phone Number

Licensure Supervisor/ Field Liaison's Email:

example@example.com

Internship Availability: Please note your schedule availability in the table above. **Center hours are available Monday - Friday, 8:30 AM - 5:00 PM., with some variations between centers. Evening hours are available for interns in the Clinical Department. This allows an understanding of interns general availability.

Availability:

Location Preferred:

	Arlington	Fort Worth	Northeast (Hurst)
First
Second
Third
Fourth

Please describe your interest in interning with Alliance For Children: *

Are you currently or have you ever received services through Alliance For Children? *

Yes No

If yes, please explain

References

Please list two (2) references that are familiar with your work life.

I authorize Alliance For Children to contact my personal references listed and understand that Alliance For Children will not be held liable for the release of this information. *

Yes No

Reference 1

Name: *

First Name Last Name

Phone Number *

Area Code Phone Number

Email address:

Relationship: *

Years Known:

Reference 2

Name: *

First Name Last Name

Phone Number *

Area Code Phone Number

Email address

Years Known:

Relationship: *

Emergency Contact

Name: *

First Name Last Name

Phone Number *

Area Code Phone Number

Email

example@example.com

Relationship: *

Background Check Release

I grant permission to Alliance For Children to initiate, via the Department of Family and Protective Services' online self-service system, a Child Abuse/Neglect Central Registry and a Texas Department of Public Service Criminal history check as well as any subsequent checks so long as I am active with the agency. I attest that the information I provide online will be correct and that providing false information is a violation of the Texas Penal Code Section 37.10 and agree to update Alliance For Children with any changes to the information above. I am a prospective intern and concent to release information regarding criminal or abuse history to Alliance For Children. I agree to update Alliance For Children with any changes to the information above.I consent to release information regarding criminal or abuse history to Alliance For Children. I ACKNOWLEDGE I HAVE READ THE ABOVE AND HAVE PROVIDED MY SIGNATURE BELOW.

Have you ever been arrested or charged with a criminal violation of law?

Yes No

Have you been involved in a child abuse investigation?

Yes No

Have you used or sold illegal drugs within the past 5 years?

Yes No

If "yes" to the above questions, please explain:

Signature

Date